Choosing a Hospice in North Dakota: Reading the Public Data

Filtering Care Compare to North Dakota

Medicare's Care Compare tool lets a family filter hospice results by state and county, showing every Medicare-certified hospice serving that area alongside its CAHPS Hospice family-experience scores and other publicly reported quality measures 1Ref 1Centers for Medicare & Medicaid Services (2024).Find Healthcare Providers: Compare Care Near You (Hospice).Supports that families can filter and compare Medicare-certified hospices by state and county on publicly reported quality and CAHPS measures.. That data comes from the Hospice Quality Reporting Program, which requires every Medicare-certified hospice nationwide to submit standardized measures or accept a reduced Medicare payment rate 2Ref 2Centers for Medicare & Medicaid Services (2024).Hospice Quality Reporting Program.Supports the existence and structure of the Hospice Quality Reporting Program that feeds Care Compare's public measures..

In North Dakota, the filtered list itself is informative: a search centered on a smaller town may return only one or two agencies, sometimes based well outside the county, rather than the dozen or more a family in a denser state might see. That is not a sign the tool is broken — it is a fairly accurate picture of how few Medicare-certified hospices actually cover the state's least populated stretches, which makes reading each one's quality measures carefully, rather than picking whichever comes up first, worth the extra few minutes.

North Dakota's 'Frontier' Counties Change What Hospice Access Looks Like

North Dakota is one of only six states that carries federal 'frontier state' status, and thirty-six of its fifty-three counties — more than two-thirds of the state — are classified frontier, meaning six or fewer residents per square mile. That designation exists because federal rural-health policy recognizes a county this sparsely populated cannot be served the way a metro county is, and it changes what a family should actually ask a hospice before enrolling.

A hospice based in Fargo, Bismarck, Grand Forks, or Minot may list a wide multi-county service area, but the honest question is how often a nurse or aide actually reaches a home two hours away, and what happens during a symptom crisis when the nearest general inpatient bed is a long drive. Continuous home care, the Medicare-defined level meant for a brief home crisis, depends on staff who can physically get there — worth asking about directly rather than assuming a service-area map on a website reflects daily reality.

What the CAHPS Hospice Survey Actually Measures

The CAHPS Hospice Survey asks the family caregivers of people who died on hospice care — typically the person who knew the patient's final months best — to rate specific domains: how well the team managed pain and other symptoms, how clearly staff communicated, whether the family got timely help, and whether they would recommend the hospice to others 3Ref 3Centers for Medicare & Medicaid Services (2024).CAHPS Hospice Survey.Supports what the CAHPS Hospice Survey is, who it samples, and which domains it measures.. CMS runs the survey nationally as a required part of hospice quality reporting, so a North Dakota family reading a hospice's CAHPS scores is looking at answers to the same standardized questions a family choosing a hospice in Arizona or choosing a hospice in California would see.

Because North Dakota hospices tend to be smaller, with fewer total patients, a published score may rest on a thinner base of survey responses than a large urban hospice's score does. That does not make the score meaningless, but it is a reason to ask a hospice directly how many completed surveys its published score reflects, rather than treating a single strong or weak domain as the whole picture.

The Live Discharge Rate: An Early-Warning Number Worth Checking First

The hospice live discharge rate — the share of patients who leave a hospice's care alive rather than through death — is one of the clearest early-warning numbers a family can check before enrolling. A national cohort study of Medicare beneficiaries discharged alive from hospice found they were more likely to be hospitalized, readmitted, or die in a hospital afterward, and that pattern was concentrated at for-profit hospices and among patients with unusually short stays 4Ref 4Peer-reviewed cohort study (see article) (2024).Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice.Supports that patients discharged alive from hospice face higher rates of hospitalization, readmission, or hospital death, concentrated at for-profit hospices and short stays..

A separate national analysis of hospices with the highest rates of these problematic live discharges found the pattern was concentrated in for-profit ownership rather than spread evenly across the industry 5Ref 5Teno JM, Plotzke M, Christian T, Gozalo P (2015).Characteristics of Hospice Programs With Problematic Live Discharges.Supports that problematic live-discharge patterns are more common at for-profit than not-for-profit hospices.. In a state where a family choosing a hospice in Alaska or choosing a hospice in Arkansas has just as few nearby options to compare, this single number is worth asking for directly rather than assuming it will show up unprompted.

Ownership and the Pattern Researchers Found

A national analysis of CAHPS Hospice results found family caregivers reported worse experiences across every measured domain — pain management, communication, timeliness, and overall rating — at for-profit hospices compared with nonprofit ones, and were less likely to recommend them 6Ref 6Anhang Price R, Parast L, Elliott MN, et al. (2023).Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences.Supports that family caregivers report worse experiences across CAHPS domains at for-profit hospices compared with nonprofit hospices.. Ownership type does not decide the outcome for any one North Dakota hospice, but it is a legitimate screening question alongside CAHPS scores and live discharge data.

Care Compare lists each hospice's ownership category directly, so confirming whether a given hospice is a nonprofit, an independent for-profit agency, or part of a multi-state chain takes only a few seconds, and it is worth doing before comparing scores rather than after.

Medicaid Has Covered Hospice for North Dakotans Since 2014

North Dakota expanded Medicaid eligibility in 2014, among the earliest wave of states to do so under the Affordable Care Act, extending coverage to adults up to 138 percent of the federal poverty level. Medicaid, like Medicare, covers hospice care once a physician certifies a terminal prognosis, with curative treatment for the terminal illness generally stopping in favor of comfort-focused care.

A decade of that coverage means North Dakota's Medicaid-eligible population has had a longer, steadier runway into the hospice benefit than residents of a state that expanded later, such as a family choosing a hospice in North Carolina, where expansion did not take effect until December 2023. What matters for a North Dakota family today is simpler: eligibility for the benefit rarely turns on when the state expanded, only on whether a physician has certified the terminal prognosis.

Checking a Hospice's License with the State

North Dakota's Department of Health and Human Services, through its Health Facilities Unit, licenses every hospice program operating in the state, and a hospice's license must be renewed annually by December 31. That renewal cycle is also the state's built-in checkpoint for reviewing complaints, inspection findings, and whether an agency continues to meet minimum staffing requirements, including a registered nurse, a social worker, and a chaplain.

A family can contact the Health Facilities Unit directly to ask whether a specific hospice's license is current and whether any complaint or enforcement history is on file — information that sits outside of, and is checked independently from, whatever Care Compare or a hospice's own marketing materials show.

Turning the Public Data Into a Same-Day Comparison

None of this requires special access. Care Compare, the CAHPS Hospice results embedded in it, and North Dakota's own licensure contact are all free and reachable in a single afternoon, even for a family comparing agencies across several counties. The goal is not finding a single best answer — Gale does not rank or recommend specific agencies — but ruling out agencies with real red flags before a family is under pressure to decide quickly.

• Confirm which Medicare-certified hospices actually serve the specific county, not just the wider region a hospice advertises.
• Ask how often a home visit realistically happens in a frontier county, and what the plan is for a symptom crisis after hours.
• Ask for the hospice's live discharge rate and its ownership type, and compare both against its CAHPS Hospice scores.
• Confirm the hospice's license is current with the state's Health Facilities Unit before signing an election form.